Provider Demographics
NPI:1235168006
Name:SHEAFFER, SARA L (DO)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:L
Last Name:SHEAFFER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:NOOKSACK COMMUNITY CLINIC
Mailing Address - City:DEMING
Mailing Address - State:WA
Mailing Address - Zip Code:98244
Mailing Address - Country:US
Mailing Address - Phone:360-966-2106
Mailing Address - Fax:360-966-2304
Practice Address - Street 1:2510 SULWHANON DR.
Practice Address - Street 2:
Practice Address - City:EVERSON
Practice Address - State:WA
Practice Address - Zip Code:98247
Practice Address - Country:US
Practice Address - Phone:360-966-2106
Practice Address - Fax:360-966-2304
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00002104207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0227980OtherWA L&I
WA8456790Medicaid
WA8456790Medicaid
WAI55339Medicare UPIN